Provider Demographics
NPI:1235500042
Name:GIPAYA, JUANITA
Entity Type:Individual
Prefix:MRS
First Name:JUANITA
Middle Name:
Last Name:GIPAYA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1151 W ROBINHOOD DR STE C6
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95207-5628
Mailing Address - Country:US
Mailing Address - Phone:209-954-1311
Mailing Address - Fax:209-951-7083
Practice Address - Street 1:1151 W ROBINHOOD DR STE C6
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95207-5628
Practice Address - Country:US
Practice Address - Phone:209-954-1311
Practice Address - Fax:209-951-7083
Is Sole Proprietor?:No
Enumeration Date:2015-10-20
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAIMF 87364106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist